Kawabe M, Fujii H, Takaoka K, Yasue T, Ohashi M, Nagasaka T, Hara K
Nihon Hifuka Gakkai Zasshi. 1989 Apr;99(5):567-77.
A 63-year-old woman presented with painless, firm, subcutaneous nodules on her legs and trunk. The lesions were annular or serpiginous and their surface was livid-red to pale-red. Superficial lymph nodes were not palpable. Upper gastrointestinal series, barium enema, Ga scintigraphy, and CT findings were negative. Histological examination revealed deep dermal vessels occupied by neoplastic cells and fibrin thrombi. We diagnosed her as having neoplastic angioendotheliosis. Electron microscopically, tumor cells lacked Weibel-Palade bodies. Immunohistochemically, the tumor cells were positive for leukocyte common antigen, T11, MT-1, HLA-DR and S-100 protein. They were negative for Factor VIII-related antigen, epithelial membrane antigen, carcinoembryonic antigen, B-1, and B-2. Immunoelectron microscopic study showed that their nuclei, cytoplasma, and cell membranes were positive for S-100 protein. Based on these findings, we diagnosed her as having T cell lymphoma. The patient rejected chemotherapy and was discharged. Three months after discharge, right hemiplegia developed. Brain CT scan revealed enhanced masses in the left frontal, temporal, and occipital lobes. Craniotomy showed only gliosis and hemorrhage. She died of cerebral bleeding three months after craniotomy.
一名63岁女性因腿部和躯干出现无痛性、质地坚硬的皮下结节而就诊。病变呈环形或匐行性，表面呈紫绀红色至淡红色。未触及浅表淋巴结。上消化道造影、钡剂灌肠、镓扫描和CT检查结果均为阴性。组织学检查显示真皮深层血管被肿瘤细胞和纤维蛋白血栓占据。我们诊断她患有肿瘤性血管内皮瘤病。电子显微镜检查显示肿瘤细胞缺乏W-P小体。免疫组织化学检查显示，肿瘤细胞对白血细胞共同抗原、T11、MT-1、HLA-DR和S-100蛋白呈阳性反应。它们对因子VIII相关抗原、上皮膜抗原、癌胚抗原、B-1和B-2呈阴性反应。免疫电子显微镜研究显示，它们的细胞核、细胞质和细胞膜对S-100蛋白呈阳性反应。基于这些发现，我们诊断她患有T细胞淋巴瘤。患者拒绝化疗并出院。出院三个月后，出现右侧偏瘫。脑部CT扫描显示左侧额叶、颞叶和枕叶有强化肿块。开颅手术仅显示胶质增生和出血。开颅手术后三个月，她死于脑出血。
